Respond to the 2 following discussion posts separately with separate references lists. Reference lists to be no older than 5 years.
1. [Onpaneeya Pataky ]
Week 4 DQ: Geriatrics with HTN & CVD…and the Ornish Program
For this discussion question, I decided to discuss the geriatric population, more specifically those with chronic hypertension and/or cardiovascular disease, which is a population I see very often in my work as a cardiac progressive care nurse in a large hospital in a mid-size city in the southeastern U. S. (Greensboro, NC). As of 2013, 44.7 million Americans or 14.1% of the population were 65 years old or older, with adults over 85 being the fastest growing group; of this group, 54.2% had hypertension and 16.5% had heart disease, while for those over 75, the percentages go up to 57.3% and 25.8% respectively (Sorrell, 2018). In addition, as of 2012, 39.7% of adults over 60 were obese, with 42.3% of women and 36.6% of men falling into this category; further, malnourishment affected 35-50% of geriatrics living in long-term care facilities as well as 65% of those in hospitals, while less than 20% of this population met aerobic and strength training exercise recommendations (Sorrell, 2018). As of 2010, 50% of older adults report problems sleeping, with 20-40% suffering from sleep-disordered breathing or apnea (Sorrell, 2018). Another significant issue affecting this population includes falls, which are a leading cause of morbidity and death; according to Healthy People 2020, each year, 2.5 million older adults are treated in EDs for fall injuries, and 250,000 of this population are hospitalized for a hip fracture (95% of which are caused by falls), with stroke being one of the primary causes (Sorrell, 2018). The sharp increase in CVD over 75 as well as problems with obesity, nutrition, exercise, sleep, and falls, indicate the need for a health promotion/disease prevention intervention program, since most elderly wait until they are sick before seeking treatment and often do not consider prevention seriously enough (Sorrell, 2018).
One of the health promotion and disease prevention programs that I feel could truly help this population—and it does not exist in my area yet—is Dr. Ornish’s Program for Reversing Heart Disease, which is a lifestyle education program with extensive coaching and group support, originally created in 1977, and typically run at hospitals and cardiac clinics, that has proven to have a dramatic effect to reverse and reduce risk for developing cardiac disease; extensive peer reviewed research confirms that this program successfully reverses heart disease—including hypertension and hyperlipidemia—as well as obesity, diabetes, prostate cancer, and depression (Ornish Lifestyle Medicine, 2022c). The program appears to currently be offered in 17 states, with the closest to my location being either 2 hours away in Rock Hill, SC, 3 hours away in Wilmington, NC, or 4 hours away in Virginia Beach, VA; this limited availability is clearly a treatment barrier for those living too far from these locations (Ornish Lifestyle Medicine, 2022a). Another potential treatment barrier would be insurance coverage and the cost of the program (approximately $10,000); currently, it is now covered by Medicare (since 2011 under “intensive cardiac rehabilitation”) and several private payers including BCBS in 14 states, Anthem, Aetna, and HMSA (Ornish Lifestyle Medicine, 2022c). It includes education, coaching, and actual group experiences in nutrition (transitioning to a low sugar-fat-cholesterol diet of mostly fruits, vegetables, whole grains, legumes, non-fat dairy, and egg whites, as well as omega 3 sources), regular moderate exercise/fitness, stress management (meditation & yoga, which has been shown to help with falls), and love/support; a significant number of participants stay connected with their groups (87.9%) and 85-90% successfully continue the program for at least one year (Ornish Lifestyle Medicine, 2022c).
Bringing such a program to a hospital or clinic involves convincing the management to do so, as a multi-person team is necessary and must complete initial in-person and online training, as well as conduct regular online meetings with Ornish Lifestyle Medicine and complete annual recertification (Ornish Lifestyle Medicine, 2022b). I would love to participate in such a program in the future, and it is one of my professional goals as both an RN and NP.
References
Sorrell, J. M. (2018). Older adult. In C. L. Edelman & E. C. Kudzma (Eds.), Health promotion throughout the lifespan (9th ed., pp. 618-649). Elsevier, Inc.
Ornish Lifestyle Medicine. (2022a). Find an Ornish-certified location. Author. https://www.ornish.com/ornish-certified-site-directory/
Ornish Lifestyle Medicine (2022b). Site certification. Author. https://www.ornish.com/site-certification/
Ornish Lifestyle Medicine. (2022c). The scientific foundation of Ornish lifestyle medicine. Author. https://www.ornish.com/proven-program/the-research/
2. [Judy Nguyen]
The majority of the population I see in my clinical practicum site are Caucasian with a few other races. According to the U.S Census Bureau, there are approximately 150,000 people living in Bellevue, making it the fifth largest city in Washington (2021). Of these people, 52% are Caucasian, 37.5% are Asian, 7.4% are Hispanics or Latino, and the rest have two or more races.
My clinical practicum site is located in Bellevue, WA. The preceptor that I am following focuses a lot of mental and behavioral health. Aside from that, he also focuses on other illness and diseases. Mental health has always been a huge issue in the U.S. but for the last two to three years, mental health has increased significantly due to the Covid-19 pandemic. According to the National Institute of Mental health (2022), it is estimated that one in five people live with a mental illness.
There are several health promotions services and programs here in Bellevue that aim to help those who has been experiencing a severe mental health crisis. Majority of these treatment centers will also provide both mental health and addiction treatment for dual diagnosis disorders for those who struggle with alcohol abuse or drug addiction. People often try to hide their depression, anxiety and suicidal thoughts because they fear the stigma of seeking help, fear of voicing their problems out loud, or are afraid that their peers might see them entering a mental health building and may be judged upon. A con to this support treatment is the financial burden one might experience as it can be expensive, especially if this is voluntary and patients do not have the proper insurance in place. Most people do not have enough funds to get the support and continued treatment that they need.
Although there are many skeptical of entering a behavioral health treatment, studies have shown that being able to talk to a professional may help reduce a patient’s anxiety, improve their mood, provide them with a greater sense of calm and inner peace, think clearer and may help reduce the risk of depression (Miller, 2019). This overall, will help with the patient’s mental and wellbeing.
References:
Miller, K. (2019, September 28). The benefits of mental health according to science. PositivePsychology.com. https://positivepsychology.com/benefits-of-mental-health/
National Institute of Mental Health. (2022, January). Mental Illness. Www.nimh.nih.gov; National Institute of Mental Health. https://www.nimh.nih.gov/health/statistics/mental-illness
U.S. census bureau quickfacts: bellevue city, washington. (2021). Www.census.gov. Retrieved from https://www.census.gov/quickfacts/bellevuecitywashington
